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Overview of Fibromyalgia

This condition is considered a syndrome of chronic muscle pain associated with a neurohormonal dysfunction of the autonomic nervous system. Individuals with this systemic condition have widespread tender or trigger points and may have symptoms associated with chronic fatigue syndrome.1 Individuals are diagnosed by a process of elimination and may require multiple tests of endocrine and immunity systems to rule out other disorders. These individuals commonly receive treatment for depression, which may also benefit from an exercise program.2 However, they find many activities difficult to perform due to diffuse, persistent pain. Individuals limit their activities in an effort to decrease or control their ongoing symptoms.

Benefits of an Exercise Program for a Client With Fibromyalgia

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Increased levels of endorphins Increased cortisol levels
Increased metabolic rate Increased lean-tissue mass
Improved sleep patterns Decreased pain and fatigue

Comorbidities to Consider

  • Depression and other mood disorders are commonly found.

Client Examination

Keys to Examination of Clients

  • Perform baseline testing of clients' mobility, posture, and flexibility before prescribing an exercise program.

  • Discuss with clients their beliefs and experience with exercise, as they may be reluctant to start an exercise program. Discuss with them the likelihood that increasing levels of activities will be associated with increased pain severity and fatigue.

Recommended Baseline Testing of Fitness Levels

  • Use the 6-minute walk test as a recommended baseline of aerobic fitness and tolerance to exercise.3

  • Employ the global pain rating scale, tender point count, and the Fibromyalgia Impact Questionnaire to establish a baseline of muscle pain symptoms.2,4

Exercise Prescription


Type: Aerobic activities, aquatic therapies, weight training

Intensity: Begin with very low levels

Duration: Short bouts of 2–5 minutes, with rest periods

Frequency: Three to four times per week

Getting Started

Aerobic exercise is considered the most important element of an exercise program for individuals with fibromyalgia, but strengthening exercises have also been found to have similar effects for changes in physical and psychological parameters.5,6,7 Aerobic exercises should be started at levels just below clients' capacity, and progressions should be gradual. Individuals may need to start with 2- to 5-minute bouts at low intensities. Aquatic exercise in warm pools (>85°F) is a highly recommended form of exercise.2 Individuals will find muscle-stretching routines and movement therapies, such as t'ai chi and Pilates, a good start to a regular exercise program.3,8 Progressing intensities to 60% to 75% of age-adjusted maximum heart rate is recommended, but clients should be taught perceived exertion methods for determining the intensity of their exercise ...

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